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Regarding Day Care Surgery list

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26 Nov, 2021 by  harivansh agrawal

Some insurers provide a list of daycare treatments they will cover like 120+ or 500+ and some will say Any day care treatment is covered like Star Health, Max Bupa, and Hdfc Ergo


My question is that is this really matter, do company like PSU insurer, Iffco Tokio, care insurance have a list so what if the Daycare surgery which is not on the list will they cover or not?


-- some say they decide case by case

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26 Nov, 2021
harivansh agrawal

Can they reject the claim if that day care surgery is not on the list

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30 Nov, 2021

Hey Harivansh!

Hope you are doing well! If the insurance company has defined a specific list of daycare treatments in the policy wordings, it means that the insurance company would settle the claim only if that daycare treatment is on their list. However, there are insurance companies that specifically write that their list is dynamic and may change in the future. Also, there are insurers (a few PSU insurers) who have mentioned that they would cover other treatments and surgeries apart from their list as well but you will have to take prior approval from the company or TPA to get the claim. These insurers may settle the claim on a case-to-case basis.

Hope this clarifies your doubt.

Thanks!

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01 Dec, 2021
harivansh agrawal
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02 Dec, 2021

You are right. However, I would not recommend you to only consider the number of daycare treatments covered under a policy as a decision-making factor. Apart from having a mandatory copay of 5%, the Aarogya Sanjeevani plan has several limits imposed on room rent and boarding, ICU charges, different types of surgeries like cataracts, a waiting period of 48 months for PED's, etc.

Considering this, going for a comprehensive plan makes more sense - even if they have defined a specific list of daycare treatments.

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02 Dec, 2021
harivansh agrawal
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02 Dec, 2021
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